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Published on: February 26, 2013
Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery
K Hosokawa1, Y Nakajima, T Umenai
1Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
Insights
Postoperative atrial fibrillation (AF) after off-pump CABG is predicted by increasing age, intraoperative temperature, and fluid balance, while a higher cardiac index reduces risk. Understanding these factors improves patient outcomes.
Area of Science:
- Cardiothoracic Surgery
- Cardiac Surgery
- Cardiology
Background:
- Postoperative atrial fibrillation (AF) is a common complication after cardiothoracic surgery.
- It increases stroke risk and hospital stay.
- Predictors of AF after off-pump CABG are not well-established.
Purpose of the Study:
- To identify predictors of AF after off-pump CABG.
- To investigate perioperative factors associated with AF.
- To understand AF pathophysiology in this patient group.
Main Methods:
- Prospective observational study of 296 patients.
- Univariate analysis of perioperative factors.
- Stepwise logistic regression for independent predictors.
Main Results:
- AF incidence was 32% and prolonged hospital stay by 3 days.
- Independent predictors: increasing age (OR 1.44), intraoperative temperature (OR 1.64), lower ICU cardiac index (OR 0.37), and intraoperative fluid balance (OR 0.96).
Conclusions:
- Ageing, intraoperative fluid balance, and postoperative cardiac index are associated with AF onset after off-pump CABG.
- These findings aid in predicting and potentially preventing AF.
- Further research into AF prevention strategies is warranted.
Background:
Postoperative atrial fibrillation (AF) is one of the most common complications after cardiothoracic surgery and is associated with an increased risk of stroke, and longer hospital stay. The pathophysiology of postoperative AF is uncertain, and its prevention remains unsatisfactory. Many previous studies have examined the predictors of AF after on-pump coronary artery bypass graft surgery (CABG), but there are few reports after off-pump CABG.
Methods:
The aim of the present prospective observational study, in which 296 consecutive patients were enrolled, was to elucidate the predictors of AF after off-pump CABG. The association of perioperative factors with AF was investigated using univariate analysis. Significant variables were included into a stepwise logistic regression model to ascertain their independent influence on the occurrence of AF.
Results:
The incidence of AF was 32%. AF prolonged the time until patients were fit for discharge by 3 days (P<0.01). Stepwise multivariate analysis identified increasing age [odds ratio (OR) 1.44 per 10-yr increase; 95% confidence interval (CI) 1.06-1.95], intraoperative average core temperature (OR 1.64; 95% CI 1.05-2.56), the average cardiac index in the intensive care unit (OR 0.37; 95% CI 0.19-0.71), and intraoperative fluid balance (OR 0.96 per 100-ml increase; 95% CI 0.93-0.99) as independent predictors of postoperative AF.
Conclusion:
Our present findings indicate that ageing, the intraoperative fluid balance, and postoperative cardiac index are associated with the onset of AF after off-pump CABG.
